- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $131.83 / $144.54
| Facility | | $32.36 | $131.83 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $32.36
| Professional | | $16.98 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.30 / $107.15
| Professional | | $12.30 | $12.30 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $102.33
| Facility | | $54.95 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $83.18 / $93.33
| Professional | | $15.49 | $83.18 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $43.65
| Facility | | $19.95 | $26.30 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $83.18
| Professional | | $25.12 | $29.51 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $47.86
| Facility | | $19.95 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $17.38 / $186.21
| Professional | | $10.47 | $17.38 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $40.74 / $40.74
| Facility | | $36.31 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $77.62
| Professional | | $75.86 | $75.86 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $91.20
| Professional | | $28.18 | $50.12 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $186.21
| Facility | | $32.36 | $38.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $144.54 / $186.21
| Professional | | $13.80 | $144.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $100.00
| Professional | | $77.62 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $25.70 / $100.00
| Facility | | $12.30 | $25.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.60 / $33.88
| Professional | | $10.47 | $16.60 | $33.88 |